Nick Xenophon's allegations that air traffic management at Melbourne's two airports have put public safety at serious risk are supported by this scathing ATSB report
The ATSB has reported on a truly third world performance by AirServices Australia in failing to properly separate two 737s using Melbourne’s main airport at Tullamarine and a helicopter above the adjacent general aviation airport at Essendon on January 26, 2016.
The safety investigator doesn’t mince words on this occasion,
On the morning of 26 January 2016, the air traffic controllers at Melbourne Airport, Victoria conducted a runway change from runway 16 for arrivals and runway 27 for departures to runway 16 for arrivals and departures. The Melbourne Tower Coordinator and the Melbourne Approach East Controller were required to coordinate the runway change with the Essendon Aerodrome Controller. However, both Melbourne controllers forgot to conduct the coordination.
At Essendon Airport, the pilot of a Robinson R44 helicopter, registered VH-WYR (WYR), had been cleared to operate overhead the airport, not above 1,500 ft, as there were overcast conditions above that level.
At 0705 Eastern Daylight-saving Time, a Boeing 737 was cleared for take-off on Melbourne runway 16. About 1 minute later, another Boeing 737 was cleared for take-off on the same runway. The Essendon Aerodrome Controller observed the first Boeing 737 departing runway 16 on their Tower Situation Awareness Display. As the controller was unaware of the change of runway at Melbourne, they believed the Boeing 737 was an uncoordinated missed approach.
Shortly after, the second Boeing 737 departure appeared on the display. The Essendon Aerodrome Controller queried the active runway with the Melbourne Planner Controller, and found out that the active runway had been changed at Melbourne Airport without the required coordination with Essendon. At 0708, the Essendon Aerodrome Controller instructed the pilot of WYR to operate over or to the east of the Essendon runway 26 threshold, ensuring a 3 NM (5.6 km) separation with the runway 16 departures from Melbourne Airport.
A review of the surveillance data confirmed losses of separation between WYR and the two Boeing 737 aircraft. At their closest, the first was 2.4 NM (4.4 km) west of and 800 ft above WYR, the second 2.5 NM (4.6 km) west of and 800 ft above. Either a 3 NM (5.6 km) surveillance separation standard or a 1,000 ft vertical separation standard was required.
What the ATSB found
The ATSB found that, while there were requirements for coordination between Melbourne and Essendon Airports, there were no documented procedures, checklists, tools or memory prompts to assist controllers to coordinate runway and airspace changes. In this case, the Melbourne Tower Coordinator and Melbourne Approach East Controller each forgot to conduct the required coordination with the Essendon Aerodrome Controller. Neither controller could explain this lapse.
The ATSB report justifies claims repeatedly made by Senator Nick Xenophon that air navigation arrangements involving the two closely located Melbourne airports are unacceptably dangerous.
Readers can draw their own conclusions as to whether the safety findings at the end of the full report here will have outcomes which are worth the paper on which any hard copies are printed.
Feb 15, 2017
It seems that air safety in Australia remains entirely a matter of business efficiency and $$$ government fees
Today’s troubling report about the safety of air traffic control in Australia on ABC News is definitely not just another union inspired story warning that job losses in this or that public service will end in a disastrous loss of life.
In this case the jobs, at Airservices Australia, are gone. They aren’t coming back. The omlette can’t be unscrambled.
‘Our jobs or your life’ became a worn out cliche riddled art form trotted out by organised labour and media before anyone alive today was born when modernisation began to threaten guard’s van on trains and signals were levered into position by physical force.
If any of the inspirations for the ABC story are actively involved in safely keeping aircraft apart then air travellers have every reason to be worried about their being sufficiently alert or ‘agile’ to perform such tasks.
But this isn’t the case. Most of the jobs that were lost were in administration, and were regarded as parasitic or superfluous to the core task of stopping the flight you may about to board this morning from coming too close to another flight at various stages of their respective intercity trips.
The legitimate concern, however well or poorly based, is whether or not the loss of back office jobs as Airservices Australia calls them, has adversely affected safety.
There was a period earlier this century when the safety investigator, the ATSB, seemed to be struggling to keep up with ‘separation incidents’ in which it identified controller fatigue and even a lack of proper training as factors in jets receiving transponder triggered TCAS potential collision warnings.
Such incidents continue to occur, there was one involving two Qantas aircraft in the vicinity of Brisbane airport recently, and there continue to be incidents which occur outside actively monitored airspace which also raise important questions about the design of airspace boundaries and the practices they involve in this country.
But the official response has for some time been that the actual incidence of proximity events in Australian airspace is no longer statistically different to the situation in busy air traffic corridors covered by similar ATC technology elsewhere in the world.
This is difficult terrain for the media to navigate, which the ABC story carefully and fairly covers. There are continuing problems in Australian airspace, it is possible that progress has been made, and as Senator Xenophon has identified in the past, some of those screw ups should never, ever have been allowed to occur, and need to be prevented from happening in the future.
The whole issue of air traffic control safety is rendered opaque by government indifference, as in this government, and its Labor predecessors. In Government eyes, Airservices Australia is a fee collecting revenue raising entity supposedly run along private industry lines.
It has never been possible to get a sensible engagement with the safety issues of ATC control from any Coalition or Labor minister since AirServices Australia began to operate as a commercial entity measured solely by its contribution to the Federal Budget. It is doubtful that any minister this century possessed even the most basic of understanding of how air traffic control works, and where changes in technology will take it (perhaps) beyond the crap that appears in press releases directed by Mandarins.
The inherent problem with the supremacy of management over old fashioned and highly inconvenient safety cultures is that management will screw down and stress the human resources of bodies like AirServices Australia until ‘something’ breaks.
That ‘something’ could end up in a stinking pile of body bags and shattered airliner parts, and wipe out a few high profile CEOs, a sporting team or two, and a few dozens of working class punters, and maybe even cause a few by-elections.
There is a serious lack of Executive oversight of safety outcomes in Australian aviation, and for that matter, road haulage, and one day, as people like Senator Xenophon have often pointed out, it might bite all of us very badly.
Feb 7, 2017
One way to keep FNQ lovely and tidy is for airlines to ensure their flights have ALL of Cairns' runway available for take-off
But for the timely intervention of an AirServices Australia officer in the tower at Cairns airport on January 21, a Tigerair Australia A320 bound for Brisbane would have attempted to take off from the wrong starting point on its 2580 metres long runway.
The flight would, according to pilots, most likely have taken off using only 2100 metres of the runway, provided nothing went wrong, such as an engine failure, or perhaps the mistaken use of less powerful but more economical thrust settings, it which case things could have gone badly wrong for everyone in the 180 seat jet.
Those are the thoughts of airline professionals who hold positions demanding complete attention to the requirements of safe airline operations, and who are aware of the pressure for quick turnarounds or punctuality.
The notification of the incident as worthy of investigation by the ATSB can be read here on its website, or a better illustrated report, and a short discussion of the incident, can be found on the Aviation Herald website, which is an invaluable free resource for those interested in no nonsense air safety reporting and which asks for a donation toward its running costs.
The ATSB expects to report its findings by May, a very short turnaround for a vital agency that is also under resourced.
Nov 8, 2016
Whoever is behind these dangerous false calls to airliners is either stupid or very poorly advised
There are two important things to know about the outbreak of fake ATC radio calls to Australian airliners in recent weeks.
The first is that ‘my voice is my identification’, as many users of the Australian Taxation Office caller ID facility would know, generates voice prints that can be compared to using fingerprints in verifying identity.
The second thing to know is that some inside knowledge of the radio frequencies and protocols used by the air traffic control system is required to be sufficiently convincing to imitate a real ATC officer to an airline pilot.
This isn’t to necessarily say the call is being made by an ATC officer in pursuit of public nuisance or industrial relations purposes. There is a significant community of aircraft watchers who monitor and study ATC communications, and on occasions, publicly post calls between aircraft and air navigation services such as Airservices Australia when there is a flight turnback, or other emergency.
But there is a massive amount of ATC voice tapes available for law enforcement authorities to run for matches beside the voice of the hoaxer or hoaxers who have been doing their mischief in recent weeks in this country.
The AFP has reason to be dismayed that the story has leaked out. An arrest would clearly from their point of view, have been preferable, and the airlines clearly want to avoid ill-informed copycat hoaxes.
Another matter to consider is that official statements that ‘safety isn’t compromised’ are nonsensical. While no-one, other than the hoaxer or hoaxers has been imperiled so far by the incidents in Australia, they do carry the risk of unintended consequences in which such a call might interfere with disastrous results with a real crisis involving an airliner in what are the busy skies that comprise the approach and departure air traffic control areas around major airports.
Jul 29, 2016
The ATSB is there to make flying safer in Australia, not to bury or avoid matters that may embarrass the airlines and their regulator and air traffic services provider
If Australia had an ATSB air crash investigator with the resources and courage to promptly deal with pressing incidents that exposed the public to severe dangers, our skies would be much safer.
The most recent example is reported in this Sydney Morning Herald account of an arriving Jetstar A320 and a departing AirAsia X A330 coming within 152 metres of each other close to the Gold Coast airport on July 21.
That specified lack of separation could not be independently confirmed earlier today, but the triggering of traffic collision avoidance system or TCAS resolution advisory warnings in both airliners with a combined count of more than 520 seats near a high profile Australian airport demands more than an ATSB estimate of an inquiry report being issued by July 2017.
The quotes from a Jetstar spokesman in the media report make the official notification from the ATSB look like part of its apparent policy of downplaying all incidents that could have ended in major loss of life.
Does the ATSB really expect that public interest to be served by not identifying, very early, whether the airliners were directed to fly towards each other in such a dangerous manner, or whether instructions were not followed by one of the aircraft? Or indeed, if some additional unexpected factor contributed to the situation? These questions could and should be answered in an interim or preliminary report no later than 30 days after the occurrence of such an incident.
Delays in reports, and downplaying of their importance, have become characteristic of the ATSB for at least nine years, after it failed to pursue a situation where a REX turboprop was flown almost all the way from Wagga Wagga to Sydney on a single engine, with passengers onboard.
The Pel-Air crash of 2009 led to the issuing of a totally discredited and subsequently withdrawn report into the ditching near Norfolk Island of a corporate jet performing a medical flight. Despite scathing Senate Committee findings into that scandal, which involved evidence of the covering up of failed regulatory oversight by CASA, and a damning independent review of the ATSB by its Canadian counterpart, and a direction by Government to conduct a fresh inquiry, Pel-Air is still a crash without a final investigative report.
The ATSB attitude to the directions of government is something like waiting for hell to freeze over.
More recently the ATSB issued a Correcting the Record attack on a Sydney Morning Herald account of the failure of Virgin Australia to keep track of the safe operations of one of its turbo-prop ATRs. (Scroll down on the above link to find the offending entry.)
While the Sydney Morning Herald seems happy to hang the author of a totally fair and accurate report out to dry, the ATSB response is unacceptable, and avoids the core issue in the article by Aubrey Martin. Like numerous posts in Plane Talking before, Mr Martin points out that an Australian registered turbo-prop, with 68 passenger seats, was allowed to fly 13 sectors over five days following damage to its tail, before Virgin Australia discovered that it was so badly bent it had to be grounded at Albury.
It was nothing but luck that stopped Virgin Australia killing dozens of passengers through a failure to ensure the safe operational conditions of part of its fleet. This failure of oversight by the carrier would have been reason to suspend the regional turbo-prop arm of the airline by CASA, and shouts for a need for urgent attention by the ATSB.
No such action has been taken, adding to legitimate concerns that Australia has second world standards when it comes to the public administration of air safety.
Seen from outside, the ATSB is under resourced. It is also more than three years since the ATSB began inquiring into the circumstances which caused a Qantas and a Virgin Australia 737 to land in dense fog at Mildura with very little remaining fuel reserves when both had originally intended to complete flights to Adelaide.
That set of incidents raised significant questions about the regulations concerning the fueling of domestic flights in this country. Yet despite a detailed interim report, the ATSB has yet to deal with this critical underlying issue in the Mildura fog emergency that overtook flights by Australia’s major domestic carriers and put hundreds of lives in peril.
The ATSB is there to make flying safer in Australia, not to bury or avoid matters that may embarrass the airlines and their regulator and air traffic services provider.
Feb 7, 2016
*Updated with YouTube link ABC News, and possibly the commercial networks, will tonight air an inflight
*Updated with YouTube link ABC News, and possibly the commercial networks, will tonight air an inflight passenger video of a set of near collisions involving two Qantas 737s and an Emirates 777 at Melbourne Airport last July. Continue reading “Passenger video gives inside view of ATC screw up at Melbourne Airport”
Aug 4, 2015
Dick Smith has written to the Minister responsible for Aviation, Deputy PM Warren Truss, describing current plans to upgrade Australian air traffic control as "verging on criminal negli
Dick Smith has written to the Minister responsible for Aviation, Deputy PM Warren Truss, describing current plans to upgrade Australian air traffic control as “verging on criminal negligence.” Continue reading “Dick Smith says ATC upgrade plans verge on ‘criminal negligence’”
Jun 27, 2015
Are we wasting millions, and destroying general aviation, by inadequately and unfairly introducing new air traffic control technology?
In recent months an important, if not broadly understood aviation issue has been pursued behind the paywall of The Australian by Dick Smith on one side and the air traffic control provider AirServices Australia on the other.
Paywalls are essential if professional journalism is to survive, but unfortunately, a model that works effectively in Australia in conjunction with broad readership hasn’t yet been proven, which means that it is questionable as to whether there has been much connection between a crucial number of readers and the issues that have been raised by the newspaper’s detailed and perceptive coverage.
Yet that continuing argument, concerning new air traffic control technology (ADS-B or automatic dependant surveillance-broadcast) is one in which ruinous costs could lead to the shorter term destruction of the already hard pressed private and general aviation sectors in this country.
GA operators and private pilots are being asked to spend substantial sums of money on equipment that makes them ADS-B visible, yet not in practice be of use in many lower flight level situations, meaning that the money spent will not deliver improved safety outcomes in airspace and approaches to a wide range of secondary or regional airstrips where they are urgently needed.
These include airports where civil airliners, hobby ultra-light flyers, parachutists, private jets, more conventional propeller light aircraft and helicopters might all be using the same airspace, such as around Ballina or Port Macquarie.
While there are many voices canvassed by The Australian stories, and the twists and turns in the narratives do not lend themselves to bland summary, the twin focuses of the row have been on the opposing positions taken by Dick Smith and Angus Houston, who is the chairman of AirServices Australia.
Angus, as he prefers to be called, says everything is fine and Dick is wrong, and has in passing taken umbrage at criticism in the Senate of the amount of money being paid to AirServices managers, who are responsible for a public enterprise which supports itself from air navigation charges and makes profits which flow straight into Treasury.
My view is that Angus underlines a problem with the administrative and executive branches in Australia, in that there is a strong preference in Government to believe anything the Mandarins tell Ministers regardless of what party or coalition is in power, and that there is sod all serious independent auditing of claims and budget efficiency.
Angus is very loyal to his organisation, and some very fine professionals within it, but perhaps insufficiently skeptical of its narrative over the application of ADS-B technology as it currently stands.
Dick isn’t the only prominent general aviation figure quoted by coverage in The Australian as to the inadequacy of the airspace management in Australia today, and the more so, under ADS-B in the near future.
If Angus were to shift modes from defending the air traffic control establishment to dealing with the need to make the reforms work without further risking the survivability of the private pilot and general aviation interests in Australia we might have progress.
It seems inescapably reasonable that spending on ADS-B and the proper management of airspace must produce a very significant improvement in air safety by diminishing risk across all flying activities that involve the sharing of the skies between larger and smaller aircraft.
Otherwise, through insupportable cost pressures and inefficiencies, the very food chain in the aviation industry in terms of training, experience and critical skills in support services will be broken, and the ‘common good’ to use an old fashioned term, will be deeply harmed.
Jun 13, 2015
Dick Smith has driven a long series of disclosures in recent weeks in The Australian of absurdities in the administration of air services and safety in this country, and
Dick Smith has driven a long series of disclosures in recent weeks in The Australian of absurdities in the administration of air services and safety in this country, and this morning’s installment concerning Lord Howe Island air traffic issues is by far the most telling. Continue reading “Air traffic control absurdities highlighted by Dick Smith”
May 29, 2015
Earlier this week the chief commissioner of the ATSB, Martin Dolan, told a Senate Estimates hearing that he had decided not to investigate a three hour radar black out at Melbourne’s main airport at Tullamarine and the nearby smaller corporate and general aviation airport at Essendon. Continue reading “ATSB admits failing to investigate serious ATC blackout in Melbourne”
Mar 21, 2015
In a week when the ATSB account of how AirServices 'lost awareness' of a
In a week when the ATSB account of how AirServices ‘lost awareness’ of a Virgin Australia 737 most of the way between Sydney and Brisbane should have received more attention, the organisation is engaged in paper warfare. Continue reading “AirServices goes four pronged, destroys three holed paper”
Mar 5, 2015
It was more than a case of air traffic control error when two Qantas A330s were inadvertently directed to fly toward each other in airspace near Adelaide in a 'loss of separation' o
It was more than a case of air traffic control error when two Qantas A330s were inadvertently directed to fly toward each other in airspace near Adelaide in a ‘loss of separation’ or near miss situation in 2013. Continue reading “Rare fault found in one of two Qantas A330s in ‘near miss’”
Mar 1, 2015
The Minister responsible for aviation and its safety, Warren Truss, has just released a statement about Australia participating with Indonesia and Malaysia in a trial of actually us
The Minister responsible for aviation and its safety, Warren Truss, has just released a statement about Australia participating with Indonesia and Malaysia in a trial of actually using to its potential existing non-radar based tracking technology on jet airliners flying across remote oceanic air routes.
Such as the one believed to have been followed to its doom in the southern Indian Ocean by missing Malaysia Airlines flight MH370, which was a 777 with 239 people and items of secret air freight on board when it crashed almost a year ago. Continue reading “Absurd MH370 related tracking statement made by Minister Truss”
Feb 27, 2015
An ABC report says the long overdue mer
An ABC report says the long overdue merger of civil and military air traffic control is at last firmly committed to by Government. This could save many lives, rather than just the money that is mentioned as driving the decision. Continue reading “Savings not safety drives Australia to merge civil military ATC”
Feb 25, 2015
While media attention was understandably diverted elsewhere in Senate Estimates hearings yesterday, AirServices Australia was given a grilling that raised some very serious safety
While media attention was understandably diverted elsewhere in Senate Estimates hearings yesterday, AirServices Australia was given a grilling that raised some very serious safety, competency and integrity issues. Continue reading “AirServices Australia grilled over integrity and competency issues”
Nov 30, 2014
A disturbing dossier of evidence as to the unsatisfactory and abjectly incompetent state of public administration of air safety in Australia is being assembled by the hard core membersh
A disturbing dossier of evidence as to the unsatisfactory and abjectly incompetent state of public administration of air safety in Australia is being assembled by the hard core membership of the Senate Standing Committees on Rural and Regional Affairs and Transport. Continue reading “Australian ATC didn’t know Melbourne flights were at risk for two years”
Oct 23, 2014
There are some reasonable points of fairness and competency in public administration that arise from that Estimates hearing. Was Ms Staib ignorant of her obligations under the Cr
Early this week during Senate Estimates hearings the CEO of AirServices Australia, Margaret Staib, was questioned as to why she didn’t refer a manager who stole up to $20,000 from the Commonwealth to the Director of Public Prosecutions. Continue reading “AirServices CEO queried over knowledge of Crimes Act”
Oct 2, 2014
Defence air traffic control at Darwin is arguably a greater risk to aviation than home grown terrorists
On 2 October 2012 near Darwin airport military air traffic controllers screwed up the safe separation of an arriving Qantaslink 717 and a departing Qantas 737 with a combined passenger capacity of about 283 seats because of a case of mistaken identity involving an RAAF C-130 which wasn’t even flying near the airport.
The C-130’s transponder code had also been inadvertently applied to the 717 flight by the civilian air traffic control system, but had been changed to a new code before it entered Darwin’s approach and departure airspace under defence control.
Except that Darwin military control had deleted the change message unread, leaving the officers handling the arrival in a state of momentary confusion as to who was doing what when suddenly nothing they were hearing or seeing at their desk matched their assumptions or expectations.
In its summary of this report the ATSB describes this inexplicable unprofessionalism or stupidity as “local contextual factors and confirmation bias”. The ATSB must think the Minister is an idiot. (See page 10 of the full report and ask yourself, if Darwin control can’t even be bothered to read AirServices messages how bleeding dangerous are these fools).
The ATSB final report into this incident is highly technical and would probably put lay readers into a coma. Use the download button for the full report, don’t rely on the summary.
It needs one of those gripping YouTube videos favoured by America’s safety investigator the NTSB to explain with moving pictures the unsafe elements of this particular incident and highlight the unsatisfactory state of affairs in which our military controllers are entrusted with the lives of hundreds of airline passengers where they use defence airspace .
While the incoming 717 crossed directly above the outgoing 737 with 900 feet to spare, infringing the safe separation distance by ‘only’ 100 feet, it is the stuff up in Darwin control that is of concern.
There has never been an incident exactly like this one, according to the ATSB report, but there is a long history of military incompetency in handling civilian aircraft movements in defence controlled airspace particularly at the shared facilities at Darwin and Newcastle airports.
And nothing, apart from the issuing of anodyne media releases by successive transport ministers, has even been done about this.
There seems to a death wish of disastrous proportions in the Department of Defence in that it continues to assert its professionalism and competency in handling passenger jets, and resist all efforts to allow civilian controllers to control civilian jets at these airports, until one day there is a terrible tragedy, because bugger all has even been done to fix the problem.
It is astonishing to read in this report that the Australian Defence Air Traffic System and the much larger civilian system have “only limited communication between them.”
The ATSB also expresses dissatisfaction with some of the responses it received from Defence.
The ATSB is not satisfied that the DoD has adequately addressed the safety issues regarding the provision of refresher training to air traffic controllers for the scanning of green radar returns and in compromised separation recovery requirements and techniques. As a result, the ATSB has made formal recommendations to the DoD to take further safety action on these issues.
Going on past performances, Defence will continue to ignore the ATSB in that nothing material will be done to end the risk that the actions of its controllers pose to the life and limb of civilian airliner passengers, and will resist as fiercely as it has in the past any suggestion that its controllers cease to exercise any control over civil movements.
However the chairmanship of AirServices Australia has passed to Air Chief Marshal Angus Houston (Retired) while its CEO is Margaret Staib, who also has a distinguished previous career in defence.
It may well be that they will recognise that this situation at shared military/civil airports in manifestly dangerous and untenable, and take decisive action to eliminate these risks.